Friday, September 04, 2015

Obama Edicts More Transgender Rights via ObamaCare

In order to protect the full-range of genders in a transformed America (where previously there were only two genders), the Obama administration has stunned the health care sector by interpreting Section 1557 of the Affordable Care Act (ObamaCare) as providing civil rights protections for the sexually confused.Gay rights advocates, such as Mara Youdelman, cheer that transgender "men" can no longer be denied a Pap smear.

"The proposed rule, Nondiscrimination in Health Programs and Activities, will assist some of the populations that have been most vulnerable to discrimination and will help provide those populations equal access to health care and health coverage."-- President Obama's Secretary of Health and Human Services, Sylvia Burwell

The Obama administration proposed a new rule Thursday that would ban discrimination against transgender people in the health care system, saying stereotypes about sexual identity have no place in provision of health insurance or medical care.

The rule prohibits insurance companies from denying coverage to transgender people, allows them the right to use the facilities, such as restrooms, according to their gender identity and says providers may not discriminate on the basis of their own notions of masculinity or femininity.

Jocelyn Samuels, head of the HHS office of civil rights, said the rule does not require insurers to pay for someone to receive sex-change treatment. Medicare and Medicaid, as well as any service providers who accept federal dollars would have to follow the rules.

In the past, several health insurance plans have categorically excluded health care related to transitioning between genders, often on the grounds that such procedures are often cosmetic, not medically necessary, and elective in nature. Now, such categorical bans will be disallowed, and insurers will have to cover many of the procedures.

HHS says the new rule won’t require insurers to cover all hormone treatments or sex reassignment surgeries, but it will almost certainly require them to cover a large number of them.

Jocelyn Samuels, director of HHS’s Office for Civil Rights, told CNBC that the new rule would prohibit insurers from denying surgeries and other procedures simply because they’re intended to treat gender dysphoria (where a person feels their body has the wrong gender) rather than some other ailment. For example, if a doctor recommended a hysterectomy (removal of the uterus) to treat gender dysphoria in a woman who identifies as a man, the insurance company couldn’t deny it if it would ordinarily follow such a recommendation for other conditions (like cancer).

Doctors' offices, hospitals, insurers and others that receive federal dollars would no longer be allowed to discriminate against gays and transgender individuals under a proposed rule from the Obama administration released Thursday.

Federal regulations already prohibit discrimination in health plans under the basis of race, color, national origin, sex, age or disability.

The rule does not just prohibit discrimination against LGBT individuals but also any discrimination based on gender identity. The rule defines gender identity as an individual's "internal sense of gender, which may be different from an individual's sex assigned at birth."

The Affordable Care Act, also known as Obamacare, was passed in 2010 [when President Obama and nearly all Democrats opposed same-sex marriage] and included anti-discrimination provisions to prevent insurers from charging customers more or denying coverage based on age or sex.

That law left some areas open to interpretation and thousands of consumers complain each year about being discriminated against, the U.S. Department of Health and Human Services said on Thursday.

The proposed rule says that individuals cannot be denied care or coverage based on sex, or gender identity, and that individuals must be treated consistent with their gender identity. Providers cannot deny or limit care based on gender and insurers cannot have policies prohibiting gender transition health services that may be offered for other reasons, such as a hysterectomy.

The National Center for Transgender Equality said it had been advocating for the policy since 2010.

“This rule actually contains the most significant affirmation of the rights of transgender individuals of equal treatment in health care and health insurance that has existed anywhere in the law,” said Samuel Bagenstos, a law professor at the University of Michigan.

The proposed rule would apply throughout the health care system — affecting most health insurers, hospitals, nursing homes and physicians. It says that the provision applies to any providers or insurers who receive “federal financial assistance,” and lists an array of funding streams that would make them subject to the rule.

Though the proposal is quite clear in its application to transgender rights, it is more vague on whether the law’s anti-discrimination provisions apply to gay, lesbian and bisexual patients. . . .

At least 10 states and the District of Columbia already require health insurers to cover some treatments for people undergoing gender transition, as do the health plans for federal workers and many large employers. . . .

The antidiscrimination regulations proposed by HHS apply to health insurance marketplaces or exchanges under the Affordable Care Act, any health program administered by HHS, and any healthcare program or activity — think medical care — that receives financial assistance from HHS. Examples of the latter include hospitals that accept Medicare patients and physicians who treat Medicaid patients.

HHS said that receiving Medicare Part B reimbursement would not subject physicians to the proposed regulations because these payments are not deemed federal financial assistance. However, physicians would come under the regulations if they earn Medicare bonuses for meaningful use of an electronic health record system. The same would be true if they receive research grants from the National Institutes of Health or work in the National Health Service Corps. Because of the pervasiveness of HHS funding, "almost all practicing physicians in the United States are reached (by the regulations," HHS said.